Health Policy Evaluation and Technology Assessment Network Meetings in Xiamen, China – New horizons for international cooperation in evidence informed policy making

2017 February 17th – 21st, Building on the launch of China Health Policy and Technology Assessment Network last December, China National Health Development Research Center (CNHDRC) hosted a series of events in Xiamen, China – marking the network’s consistent progress towards evidence-informed healthcare in China as well as building capacities for China’s HTA network.Kalipso Chalkidou, Reetan Patel, & Mohamed Gad of the iDSI Global Health and Development group (GHD, formerly NICE International), along with Tony Culyer of the university of York, Mike Roberts of UCL Partners and other UK and international colleagues participated in the meetings held in Xiamen. These included leadership training, a dissemination meeting on a project relating to integrated care pathways for chronic disease in China supported by the Prosperity Fund, and an iDSI HTA workshop.

Following successful launch of this UK supported Prosperity Fund project on July 28th 2016, the dissemination meeting had the key aim of communicating progress in establishing a standardised approach to clinical guidelines development, and in applying them to update existing care pathways in China. The topic areas selected for the pilot were on priority chronic disease areas namely hypertension and diabetes that were currently in use in Xiamen and Qingdao cities.

A representative on the behalf of CNHDRC Director General- Ms Wei Fu gave an opening speech where he provided an overview of the burden of chronic diseases in China. He described China’s aging population as a critical high priority issue, highlighting the estimated 220 million people aged above 60 in China, added to by about 8 million people per year. He emphasized the significance of establishing a ‘tiered healthcare system’ in China utilizing UK NHS expertise and experience to support the local development of standardised care pathways. He concluded by inviting the audience of about 50 in number consisting of senior officials from Xiamen Health and Qingdao Health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians- to share the results of the preliminary version of the guidelines handbook, and encouraged feedback and discussion among attendees.

Ashwini Kirchner, Head of Health and Social Care at the British Embassy in Beijing highlighted the importance of bilateral commitment between the UK and China, to learn from one another. She stated that healthcare is a key point of interest between the two countries. Kirchner highlighted the aims of Prosperity Fund Project in providing cutting edge policy in an area where the UK can offer expertise, and to give way for a real impact on the ground.

Kun Zhao, Division Director in CNHDRC, described the status quo and progress of Chinese guidelines development. She compared UK and Chinese guidelines, and provided recommendations for realizing the project aims. She linked the importance of robust guidelines development with the considerable uncertainty around the effectiveness of most of new technologies in China, and the absence of economic and equity perspective in setting hospital treatment standards in different regions in China.

The preliminary version of the Chinese guidelines handbook received strong positive feedback from the audience. Changqin Liu, Vice President of the first affiliated hospital of Xiamen University noted the professionalism underpinning the handbook and described it as a first of its kind to be developed in China.

“This guidelines handbook is very comprehensive…It is first time where we can align with UK Clinical Guidelines principles….I learned a lot”
Fusong Liu- Cardiology department Director of The Third People’s hospital of Qingdao.

Professor Mike Roberts of UCL Partners concluded the meeting by giving a brief presentation on new models of care in the UK, such as ‘Integrated Care Pioneers’ and ‘Vanguard sites’. His presentation can be found here.

2- Leadership & Change Management trainingFebruary 17th – Afternoon

Leading Change: New guidelines, new approach..

The afternoon session was dedicated to a training workshop that builds on the introduction of the new guidelines in Xiamen and Qingdao hospitals. According to Mike Roberts, the implementation of new guidelines depends on a number of factors, the most important of which are understanding and managing the change process involved, and developing effective leadership among the interdisciplinary teams adopting the new hypertension and diabetes clinical guidelines.

The training workshop took place over 3 hours and involved presentations on change management by Reetan Patel, effective team leadership by Mike Roberts, combined with an interactive discussion and group work scenarios. The group work emphasised the experience of trying to implement a new set of clinical guidelines and how they may be understood from different perspectives among the stakeholders affected such as management, clinicians and other various implementing teams. The audience were mainly senior officials from Xiamen and Qingdao health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians.

The role of HTA in international development & National Regulatory Authority strengthening

The iDSI HTA workshop in Xiamen builds on the MOU supporting informed implementation framework for HTA between GHD and CNHDRC. The two-day workshop revolved around 6 main themes: standardised methods for economic evaluation, non-budget constraints and health system strengthening, measuring HTA impact and return on investment, HTA and medical devices, economic evaluation modelling and public health, and adapting HTA to the Chinese context.

The workshop commenced with an opening statement by a representative of CNHDRC on the behalf of Deputy Director Hongwei Yang, who emphasized that the current leadership in China is very supportive of HTA capacity building especially in light of major technology transformation in China.

Kalipso Chalkidou gave an overview of the objectives of the HTA workshop including outlining the role of iDSI HTA hubs for supporting national and regional HTA related activities: her presentation can be found here. Kun Zhao introduced the China HTA network, which is a network of 29 institutions and hospitals backed with a great amount of support by the Chinese healthcare authorities (the presentation can be found here). Tony Culyer briefly introduced the iDSI Reference Case, what it is and how it can be adapted to China context (see his presentation here).

Professor Pete Smith of Imperial College London delivered a presentation on developing a framework for evaluating interventions aimed at health system strengthening. Eleanor Grieve of University of Glasgow talked about developing a theoretical framework for assessing the impact of HTA and the return on investment. Professor Klim McPherson of Oxford University provided a presentation on role of epidemiological modelling to support decisions in public health, and Anastasia Chalkidou and Naomi Herz of KiTEC talked about assessing medical devices and the challenge of incorporating economic evaluations in that field (their presentations can be found here).

The iDSI HTA workshop provided an opportunity for new collaborations between Chinese HTA specialists, UK researchers, and colleagues from neighbouring countries. During the second day of the workshop, a roundtable discussion involving health officials and academics from Indonesia, Cambodia and China highlighted the interest in engaging in mutual cooperation, and the opportunity offered by the Chinese HTA network in providing regional support. The rise of China’s HTA capacity comes at a pivotal timing given the upcoming BRICS Summit scheduled to take place in Xiamen next September. The five key priority areas for BRICS collaboration are: deepening cooperation, strengthening global governance, making institutional improvements and building broader partnerships. Within this context, HTA capacity buidling and wider heathcare refirm offers one important route to achieve these aims. The Goa declaration highlights the importance of BRICS cooperation in the area of healthcare regulation.

“We will seek to identify possibilities for cooperation among our health and/or regulatory authorities, with a view to share best practices and discuss challenges, as well as identifying potential areas for convergence”8th BRICS Summit- Goa Declaration October 2016.

China’s role in international support has been given added impetus by a number of initiatives including the recent “One Belt One Road” strategy. Such initiatives can provide important opportunities for sustainable development in countries along the Silk Road Economic Belt, and will be crucial in supporting the spread of evidence informed healthcare decision making in LMICs, a key objective of iDSI.